329 Neonatal Perinatal Peds 07012013

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ACGME Program Requirements for

Graduate Medical Education

in Neonatal-Perinatal Medicine

ACGME Approved: September 12, 2006; Effective: July 1, 2007 ACGME Approved Focused Revision: September 30, 2012; Effective: July 1, 2013



Subspecialties of Pediatrics 1

ACGME Program Requirements for Graduate Medical Educationin the Subspecialties of Pediatrics

Common Program Requirements are in BOLD

Introduction

Int.A. Residency is an essential dimension of the transformation of the medicalstudent to the independent practitioner along the continuum of medicaleducation. It is physically, emotionally, and intellectually demanding, andrequires longitudinally-concentrated effort on the part of the resident.

The specialty education of physicians to practice independently isexperiential, and necessarily occurs within the context of the health caredelivery system. Developing the skills, knowledge, and attitudes leading toproficiency in all the domains of clinical competency requires the residentphysician to assume personal responsibility for the care of individualpatients. For the resident, the essential learning activity is interaction with

patients under the guidance and supervision of faculty members who givevalue, context, and meaning to those interactions. As residents gainexperience and demonstrate growth in their ability to care for patients, theyassume roles that permit them to exercise those skills with greater independence. This concept--graded and progressive responsibility--is oneof the core tenets of American graduate medical education. Supervision inthe setting of graduate medical education has the goals of assuring theprovision of safe and effective care to the individual patient; assuring eachresident’s development of the skills, knowledge, and attitudes required toenter the unsupervised practice of medicine; and establishing a foundationfor continued professional growth.

Int.B. In addition to complying with the requirements in this document, each programmust comply with the program requirements for the respective subspecialty,which may exceed the minimum requirements set forth here. (Core)*

Int.C. An accredited pediatric subspecialty program must exist in conjunction with andbe an integral part of a core pediatric residency program accredited by the

Accreditation Council for Graduate Medical Education (ACGME). (Core)

Int.D. The fellows and faculty must interact with the residents in the core pediatricsresidency program. (Core)

Int.D.1. Lines of responsibility for the pediatric residents and the fellows must be

clearly defined.(Core)

Int.D.2. The presence of a subspecialty program should not adversely affect theeducation of pediatric residents. (Core)

Int.E. This document includes the ACGME Common Program Requirements whichincorporate the competencies into fellowship training. Core and subspecialtyprogram directors should work together to achieve this goal. Close coordinationamong core and subspecialty program directors will foster consistent




expectations in regard to fellows’ achievement of competencies, and for facultywith regard to evaluation processes. (Core)

Int.F. Duration of Educational Experience

Unless specified otherwise in the program requirements, pediatric subspecialty

programs must provide three years of training. (Core)

Int.G. Scope of Educational Experience

Int.G.1. Each subspecialty program must be organized and conducted in a waythat ensures an appropriate environment for the well-being and care of the patients, and provides adequate training for fellows in the diagnosisand management of those subspecialty patients. (Core)

Int.G.1.a) This must include progressive clinical, technical, and consultativeexperiences that will enable the fellow to develop expertise as aconsultant in the subspecialty. (Core)

Int.G.2. Fellows in the subspecialty program must develop a commitment tolifelong learning, and the program must emphasize scholarship, self-instruction, development of critical analysis of clinical problems, and theability to make appropriate decisions. Progressive acquisition of skill ininvestigative efforts related to the subspecialty is essential. (Core)

Int.G.3. The program must provide fellows with instruction and opportunities tointeract effectively with patients, patients’ families, professionalassociates, and others in carrying out their responsibilities as physiciansin the specialty. (Core)

Int.G.3.a) Fellows must learn to create and sustain a therapeutic relationshipwith patients, and how to work effectively as members or leadersof patient care teams or other groups in which they participate asa researcher, educator, health advocate, or manager. (Core)

I. Institutions

I.A. Sponsoring Institution

One sponsoring institution must assume ultimate responsibility for theprogram, as described in the Institutional Requirements, and thisresponsibility extends to fellow assignments at all participating sites. (Core)

The sponsoring institution and the program must ensure that the programdirector has sufficient protected time and financial support for his or her educational and administrative responsibilities to the program. (Core)

I.A.1. The pediatric subspecialty program must be sponsored by the sameinstitution that sponsors the related core pediatrics program. (Core)

I.A.2. Each subspecialty program will be evaluated by the Review Committee at




regular intervals, in conjunction with a review of the related corepediatrics program.

I.B. Participating Sites

I.B.1. There must be a program letter of agreement (PLA) between the

program and each participating site providing a requiredassignment. The PLA must be renewed at least every five years. (Detail)

The PLA should:

I.B.1.a) identify the faculty who will assume both educational andsupervisory responsibilities for fellows; (Detail)

I.B.1.b) specify their responsibilities for teaching, supervision, andformal evaluation of fellows, as specified later in thisdocument; (Detail)

I.B.1.c) specify the duration and content of the educationalexperience; and, (Detail)

I.B.1.d) state the policies and procedures that will govern felloweducation during the assignment. (Detail)

I.B.2. The program director must submit any additions or deletions of participating sites routinely providing an educational experience,required for all fellows, of one month full time equivalent (FTE) or more through the Accreditation Council for Graduate MedicalEducation (ACGME) Accreditation Data System (ADS). (Core)

I.B.2.a) Copies of these written arrangements, specifying administrative,organizational, and educational relationships, must accompany anapplication for initial accreditation. (Detail)

I.B.2.b) At subsequent reviews, these documents need not be submitted,but must be available for review by the site-visitor. (Detail)

I.B.3. An accredited program may occur in one or more sites. The ReviewCommittee must approve any site providing six months or more of theinpatient and/or outpatient training. (Detail)

II. Program Personnel and Resources

II.A. Program Director

II.A.1. There must be a single program director with authority andaccountability for the operation of the program. The sponsoringinstitution’s GMEC must approve a change in program director. (Core)

II.A.1.a) The program director must submit this change to the ACGMEvia the ADS. (Core)




II.A.2. The program director should continue in his or her position for alength of time adequate to maintain continuity of leadership andprogram stability. (Detail)

II.A.3. Qualifications of the program director must include:

II.A.3.a) requisite specialty expertise and documented educationaland administrative experience acceptable to the ReviewCommittee; (Core)

II.A.3.b) current certification in the specialty by the American Board of Pediatrics, or specialty qualifications that are acceptable tothe Review Committee; (Core)

II.A.3.b).(1) Qualifications other than subspecialty certification by the American Board of Pediatrics will be considered only inexceptional circumstances. Qualifications would include

subspecialty training in the subspecialty area, activeparticipation in national societies, evidence of on-goingscholarship documented by contributions to the peer-reviewed literature in the subspecialty, and presentationsat national meetings in the subspecialty. (Detail)

II.A.3.c) current medical licensure and appropriate medical staff appointment; and, (Core)

II.A.3.d) a record of ongoing involvement in scholarly activities, includingpeer review publications, and mentoring (i.e., guiding fellows inthe acquisition of competence in the clinical, teaching, research

and advocacy skills pertinent to the discipline).(Detail)

II.A.4. The program director must administer and maintain an educationalenvironment conducive to educating the fellows in each of theACGME competency areas. (Core)

The program director must:

II.A.4.a) oversee and ensure the quality of didactic and clinicaleducation in all sites that participate in the program; (Core)

II.A.4.b) approve a local director at each participating site who is

accountable for fellow education;(Core)

II.A.4.c) approve the selection of program faculty as appropriate; (Core)

II.A.4.d) evaluate program faculty; (Core)

II.A.4.e) approve the continued participation of program faculty basedon evaluation; (Core)




II.A.4.f) monitor fellow supervision at all participating sites; (Core)

II.A.4.g) prepare and submit all information required and requested bythe ACGME; (Core)

II.A.4.g).(1) This includes but is not limited to the program

information forms and annual program fellow updatesto the ADS, and ensure that the information submittedis accurate and complete. (Core)

II.A.4.h) ensure compliance with grievance and due processprocedures as set forth in the Institutional Requirements andimplemented by the sponsoring institution; (Detail)

II.A.4.i) provide verification of fellowship education for all fellows,including those who leave the program prior to completion;(Detail)

II.A.4.j) implement policies and procedures consistent with theinstitutional and program requirements for fellow duty hoursand the working environment, including moonlighting. (Core)

and, to that end, must:

II.A.4.j).(1) distribute these policies and procedures to the fellowsand faculty; (Detail)

II.A.4.j).(2) monitor fellow duty hours, according to sponsoringinstitutional policies, with a frequency sufficient toensure compliance with ACGME requirements; (Core)

II.A.4.j).(3) adjust schedules as necessary to mitigate excessiveservice demands and/or fatigue; and, (Detail)

II.A.4.j).(4) if applicable, monitor the demands of at-home call andadjust schedules as necessary to mitigate excessiveservice demands and/or fatigue. (Detail)

II.A.4.k) monitor the need for and ensure the provision of back upsupport systems when patient care responsibilities areunusually difficult or prolonged; (Detail)

II.A.4.l) comply with the sponsor ing institution’s written policies andprocedures, including those specified in the InstitutionalRequirements, for selection, evaluation and promotion of fellows, disciplinary action, and supervision of fellows; (Detail)

II.A.4.m) be familiar with and comply with ACGME and ReviewCommittee policies and procedures as outlined in the ACGMEManual of Policies and Procedures; (Detail)




II.A.4.n) obtain review and approval of the sponsoring institution’sGMEC/DIO before submitting information or requests to theACGME, including: (Core)

II.A.4.n).(1) all applications for ACGME accreditation of newprograms; (Detail)

II.A.4.n).(2) changes in fellow complement; (Detail)

II.A.4.n).(3) major changes in program structure or length of training; (Detail)

II.A.4.n).(4) progress reports requested by the Review Committee;(Detail)

II.A.4.n).(5) responses to all proposed adverse actions; (Detail)

II.A.4.n).(6) requests for increases or any change to fellow duty

hours; (Detail)

II.A.4.n).(7) voluntary withdrawals of ACGME-accreditedprograms; (Detail)

II.A.4.n).(8) requests for appeal of an adverse action; (Detail)

II.A.4.n).(9) appeal presentations to a Board of Appeal or theACGME; and, (Detail)

II.A.4.n).(10) proposals to ACGME for approval of innovativeeducational approaches. (Detail)

II.A.4.o) obtain DIO review and co-signature on all programinformation forms, as well as any correspondence or document submitted to the ACGME that addresses: (Detail)

II.A.4.o).(1) program citations, and/or, (Detail)

II.A.4.o).(2) request for changes in the program that would havesignificant impact, including financial, on the programor institution. (Detail)

II.A.4.p) ensure that the fellows are mentored in their development of

clinical, educational, and administrative skills;(Detail)

II.A.4.q) be responsible for the creation of a core curriculum in scholarlyactivities, the identification of a mentor, and the identification andmonitoring of a scholarship oversight committee responsible for overseeing and assessing the progress of each fellow; and, (Core)

II.A.4.q).(1) Where appropriate, the core curriculum in scholarlyactivities should be a collaborative effort involving all of the




pediatric subspecialty programs in the institution; (Detail)

II.A.4.r) have documentation of meetings that describe ongoing interactionamong pediatric subspecialty and core program directors. (Detail)

II.A.4.r).(1) These must take place at least semi-annually. (Detail)

II.A.4.r).(2) These meetings should address a departmental approachto common educational issues and concerns (e.g., corecurriculum, competencies, and evaluation). (Detail)

II.B. Faculty

II.B.1. At each participating site, there must be a sufficient number of faculty with documented qualifications to instruct and supervise allfellows at that location. (Core)

The faculty must:

II.B.1.a) devote sufficient time to the educational program to fulfilltheir supervisory and teaching responsibilities; and todemonstrate a strong interest in the education of fellows, and(Core)

II.B.1.b) administer and maintain an educational environmentconducive to educating fellows in each of the ACGMEcompetency areas. (Core)

II.B.2. The physician faculty must have current certification in the specialtyby the American Board of Pediatrics, or possess qualifications

judged acceptable to the Review Committee.(Core)

II.B.2.a) Acceptable qualifications for the required key subspecialty facultyinclude: (Core)

II.B.2.a).(1) certification, if eligible, by the American Board of Pediatrics(ABP) or other appropriate board of the American Board of Medical Specialties (ABMS), or (Core)

II.B.2.a).(2) if trained elsewhere and not eligible for certification,documented subspecialty training and peer-reviewedpublications in the field with evidence of active participation

in applicable local and national professional societies.(Detail)

II.B.2.b) When assessing the adequacy of the number of faculty, the totalnumber of fellows will be considered. (Detail)

II.B.2.c) In addition to the subspecialty program director, there must be atleast one other member of the teaching staff qualified in thesubspecialty. In some of the subspecialties, two or more additionalsubspecialists are required. Specific details are included in the




related specialty-specific section of the requirements. (Core)

II.B.2.d) If the program is conducted at more than one institution, amember of the teaching staff of each participating site must bedesignated to assume responsibility for the day-to-day activities of the program at that site, with overall coordination by the program

director. (Detail)

II.B.2.e) Appropriate teaching and consultant faculty in the full range of pediatric subspecialties and in other related disciplines also mustbe available. (Core)

II.B.2.e).(1) An anesthesiologist, pathologist, and a radiologist whohave substantial experience with pediatric problems andwho interact with the fellows are essential. (Detail)

II.B.2.e).(2) The other related disciplines should include medicalgenetics, child neurology, child and adolescent psychiatry,

as well as pediatric surgery and surgical subspecialties, asappropriate to the subspecialty. (Detail)

II.B.3. The physician faculty must possess current medical licensure andappropriate medical staff appointment. (Core)

II.B.4. The nonphysician faculty must have appropriate qualifications intheir field and hold appropriate institutional appointments. (Core)

II.B.5. The faculty must establish and maintain an environment of inquiryand scholarship with an active research component. (Core)

II.B.5.a) The faculty must regularly participate in organized clinicaldiscussions, rounds, journal clubs, and conferences. (Detail)

II.B.5.b) Some members of the faculty should also demonstratescholarship by one or more of the following:

II.B.5.b).(1) peer-reviewed funding; (Detail)

II.B.5.b).(2) publication of original research or review articles inpeer-reviewed journals, or chapters in textbooks; (Detail)

II.B.5.b).(3) publication or presentation of case reports or clinical

series at local, regional, or national professional andscientific society meetings; or, (Detail)

II.B.5.b).(4) participation in national committees or educationalorganizations. (Detail)

II.B.5.c) Faculty should encourage and support fellows in scholarlyactivities. (Core)




II.B.5.d) Research may be in a variety of fields related to the subspecialty(e.g., basic science, clinical, health services, health policy, or educational research). This should include the mentoring of fellows as they apply scientific principles, epidemiology,biostatistics, and evidence-based medicine to the clinical care of patients; (Detail)

II.B.5.e) To provide an appropriate environment for the fellows, thefellowship faculty must have a program of ongoing scholarship.

(Core)

II.B.5.e).(1) This should be characterized by peer reviewed fundingand publications. (Detail)

II.B.5.e).(2) The teaching faculty must play a substantial role inconceiving and writing the funding application (s),conducting the project, collecting and analyzing data, andpublishing results. (Detail)

II.B.5.e).(3) A scholarly environment outside of the training programcan supplement but not replace the scholarly environmentwithin the training program; (Detail)

II.B.5.f) Although an individual faculty member may not be accomplishedin all four areas of scholarship, the program faculty must exhibit allfour. (Core)

II.B.5.f).(1) In particular, a program must provide evidence of anongoing commitment to, and productivity in, thescholarship of discovery in the relevant pediatric

subspecialty area.(Detail)

II.B.5.f).(2) Recent productivity by the program faculty and by thefellows will be assessed at the time of each review of theprogram. (Core)

II.B.5.f).(3) Activity in the following is required as evidence of thecommitment to scholarship: projects with peer review for funding, and publications of original research and/or criticalmeta-analyses, systematic reviews of clinical practice,critical analyses of public policy, or curricular developmentprojects in peer-reviewed journals. (Core)

II.C. Other Program Personnel

The institution and the program must jointly ensure the availability of allnecessary professional, technical, and clerical personnel for the effectiveadministration of the program. (Core)

II.C.1. The professional personnel should include nutritionists, social workers,respiratory therapists, pharmacists, subspecialty nurses, physical and




occupational therapists, child life therapists, and speech therapists withpediatric focus and experience, as appropriate to the subspecialty. (Detail)

II.D. Resources

The institution and the program must jointly ensure the availability of

adequate resources for fellow education, as defined in the specialtyprogram requirements. (Core)

II.D.1. Adequate inpatient and outpatient facilities, as specified in therequirements for each subspecialty, must be available. (Core)

II.D.1.a) These must be of sufficient size and be appropriately staffed andequipped to meet the educational needs of the subspecialtyprogram. (Detail)

II.D.2. Support services must include the clinical laboratories, intensive care,nutrition, occupational and physical therapy, pathology, pharmacology,

mental health, diagnostic imaging, respiratory therapy, and socialservices. (Detail)

II.D.3. Patients should range in age from newborn through young adulthood, asappropriate. (Core)

II.D.3.a) Adequate numbers of pediatric subspecialty inpatients andoutpatients, both new and follow up, must be available to providea broad experience for the fellows. (Core)

II.D.3.b) The program must maintain an appropriate balance among thenumber and variety of patients, the number of preceptors, and the

number of fellows in the program.(Core)

II.D.3.b).(1) Occasionally programs may use defined clinicalexperiences at participating sites to supplement the clinicalexperience and patient population at the primary clinicalsite. Where that is the case, the program director mustsubmit detailed information to demonstrate that the clinicalexposure to the population (s) in question is sufficientlyconsistent to provide each fellow with an adequateexperience during the limited time at the affiliated site (s);e.g., if a fellow is spending two months at an affiliated siteto meet required exposure to patients with congenital heart

disease, annual data regarding numbers and types of patients in this category must be provided. (Detail)

II.E. Medical Information Access

Fellows must have ready access to specialty-specific and other appropriatereference material in print or electronic format. Electronic medical literaturedatabases with search capabilities should be available. (Detail)




III. Fellow Appointments

III.A. Eligibility Criteria

The program director must comply with the criteria for fellow eligibility asspecified in the Institutional Requirements. (Core)

III.A.1. Prerequisite training for entry into a pediatric subspecialty program shouldinclude the satisfactory completion of an ACGME-accredited pediatricresidency or other training suitable to the program director. (Core)

III.A.1.a) Candidates who do not meet this criterion must be advised inwriting by the program director to consult the American Board of Pediatrics or other appropriate board regarding their eligibility for subspecialty certification. (Detail)

III.B. Number of Fellows

The program’s educational resources must be adequate to support thenumber of fellows appointed to the program. (Core)

III.B.1. The program director may not appoint more fellows than approvedby the Review Committee, unless otherwise stated in the specialty-specific requirements. (Core)

III.C. Fellow Transfers

III.C.1. Before accepting a fellow who is transferring from another program,the program director must obtain written or electronic verification of previous educational experiences and a summative competency-

based performance evaluation of the transferring fellow.(Detail)

III.C.2. A program director must provide timely verification of fellowshipeducation and summative performance evaluations for fellows whomay leave the program prior to completion. (Detail)

III.D. Appointment of Fellows and Other Learners

The presence of other learners (including, but not limited to, residents fromother specialties, subspecialty fellows, PhD students, and nursepractitioners) in the program must not interfere with the appointed fellows’education. (Core)

III.D.1. The program director must report the presence of other learners tothe DIO and GMEC in accordance with sponsoring institutionguidelines. (Detail)

IV. Educational Program

IV.A. The curriculum must contain the following educational components:




IV.A.1. Overall educational goals for the program, which the program mustmake available to fellows and faculty; (Core)

IV.A.2. Competency-based goals and objectives for each assignment ateach educational level, which the program must distribute to fellowsand faculty at least annually, in either written or electronic form; (Core)

IV.A.3. Regularly scheduled didactic sessions; (Core)

IV.A.4. Delineation of fellow responsibilities for patient care, progressiveresponsibility for patient management, and supervision of fellowsover the continuum of the program; and, (Core)

IV.A.5. ACGME Competencies

The program must integrate the following ACGME competenciesinto the curriculum: (Core)

IV.A.5.a) Patient Care and Procedural Skills

IV.A.5.a).(1) Fellows must be able to provide patient care that iscompassionate, appropriate, and effective for thetreatment of health problems and the promotion of health. Fellows: (Outcome)

IV.A.5.a).(1).(a) must acquire the necessary clinical skills used inthe subspecialty. These skills include developmentof expertise in the ability to perform a history andphysical examination, make diagnostic andtherapeutic decisions, develop and carry out

management plans, counsel patients and families,and use information technology to optimize patientcare. (Outcome)

IV.A.5.a).(2) Fellows must be able to competently perform allmedical, diagnostic, and surgical proceduresconsidered essential for the area of practice. Fellows:(Outcome)

IV.A.5.a).(2).(a) must demonstrate competence in performing andinterpreting the results of laboratory tests anddiagnostic procedures for use in patient care.(Outcome)

IV.A.5.a).(2).(a).(i) Fellows must acquire the necessaryprocedural skills and develop anunderstanding of their indications, risks, andlimitations. (Outcome)

IV.A.5.a).(2).(a).(ii) Each fellow’s experience in suchprocedures must be documented by the




program director and such documentationmust be available for review. (Detail)

IV.A.5.b) Medical Knowledge

Fellows must demonstrate knowledge of established and

evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of thisknowledge to patient care. Fellows: (Outcome)

IV.A.5.b).(1) must have a working understanding of biostatistics, clinicaland laboratory research methodology, study design,preparation of applications for funding and/or approval of clinical research protocols, critical literature review,principles of evidence-based medicine, ethical principlesinvolving clinical research, and the achievement of proficiency in teaching for all subspecialty fellows. (Outcome)

IV.A.5.c) Practice-based Learning and Improvement

Fellows must demonstrate the ability to investigate andevaluate their care of patients, to appraise and assimilatescientific evidence, and to continuously improve patient carebased on constant self-evaluation and life-long learning.(Outcome)

Fellows are expected to develop skills and habits to be ableto meet the following goals:

IV.A.5.c).(1) identify strengths, deficiencies, and limits in one’s

knowledge and expertise;(Outcome)

IV.A.5.c).(2) set learning and improvement goals; (Outcome)

IV.A.5.c).(3) identify and perform appropriate learning activities;(Outcome)

IV.A.5.c).(4) systematically analyze practice using qualityimprovement methods, and implement changes withthe goal of practice improvement; (Outcome)

IV.A.5.c).(5) incorporate formative evaluation feedback into daily

practice;(Outcome)

IV.A.5.c).(6) locate, appraise, and assimilate evidence fromscientific studies related to their patients’ healthproblems; (Outcome)

IV.A.5.c).(7) use information technology to optimize learning;(Outcome)




IV.A.5.c).(8) participate in the education of patients, families,students, fellows and other health professionals; and,(Outcome)

IV.A.5.c).(9) self-evaluate performance and incorporate assessmentsprovided by faculty, peer and patients (Outcome)

IV.A.5.c).(9).(a) This should be a component of the individuallearning plan. (Core)

IV.A.5.d) Interpersonal and Communication Skills

Fellows must demonstrate interpersonal and communicationskills that result in the effective exchange of information andcollaboration with patients, their families, and healthprofessionals. (Outcome)

Fellows are expected to:

IV.A.5.d).(1) communicate effectively with patients, families, andthe public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; (Outcome)

IV.A.5.d).(2) communicate effectively with physicians, other healthprofessionals, and health related agencies; (Outcome)

IV.A.5.d).(3) work effectively as a member or leader of a health careteam or other professional group; (Outcome)

IV.A.5.d).(4) act in a consultative role to other physicians and

health professionals;(Outcome)

IV.A.5.d).(5) maintain comprehensive, timely, and legible medicalrecords, if applicable; and, (Outcome)

IV.A.5.d).(6) teach proficiently, understand the principles of adultlearning, and provide skills to participate effectively incurriculum development, delivery of information, provisionof feedback to learners, and assessment of educationaloutcomes. (Outcome)

IV.A.5.d).(6).(a) Graduates should be effective in teaching both

individuals and groups of learners in clinicalsettings, classrooms, lectures, and seminars, andalso by electronic and print modalities. (Outcome)

IV.A.5.e) Professionalism

Fellows must demonstrate a commitment to carrying outprofessional responsibilities and an adherence to ethicalprinciples. (Outcome)




Fellows are expected to demonstrate:

IV.A.5.e).(1) compassion, integrity, and respect for others; (Outcome)

IV.A.5.e).(2) responsiveness to patient needs that supersedes self-

interest; (Outcome)

IV.A.5.e).(3) respect for patient privacy and autonomy; (Outcome)

IV.A.5.e).(4) accountability to patients, society and the profession;and, (Outcome)

IV.A.5.e).(5) sensitivity and responsiveness to a diverse patientpopulation, including but not limited to diversity ingender, age, culture, race, religion, disabilities, andsexual orientation. (Outcome)

IV.A.5.f) Systems-based Practice

Fellows must demonstrate an awareness of andresponsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal health care.(Outcome)

Fellows are expected to:

IV.A.5.f).(1) work effectively in various health care deliverysettings and systems relevant to their clinical

specialty;(Outcome)

IV.A.5.f).(2) coordinate patient care within the health care systemrelevant to their clinical specialty; (Outcome)

IV.A.5.f).(3) incorporate considerations of cost awareness andrisk-benefit analysis in patient and/or population-based care as appropriate; (Outcome)

IV.A.5.f).(4) advocate for quality patient care and optimal patientcare systems; (Outcome)

IV.A.5.f).(5) work in interprofessional teams to enhance patientsafety and improve patient care quality; (Outcome)

IV.A.5.f).(6) participate in identifying system errors andimplementing potential systems solutions; (Outcome)

IV.A.5.f).(7) participate in the administrative aspects of thesubspecialty, including: (Outcome)




IV.A.5.f).(7).(a) an awareness of regional and national access tocare, resources, workforce, and financingappropriate to their specialty through guidedreading and discussion; and, (Outcome)

IV.A.5.f).(7).(b) organization and management of a subspecialty

service within one’s own delivery system byengaging fellows as active participants indiscussions (e.g., through already scheduleddivision activities/meetings ) that involve: (Outcome)

IV.A.5.f).(7).(b).(i) staffing a service or unit, includingmanaging personnel and making andadhering to a schedule; (Outcome)

IV.A.5.f).(7).(b).(ii) drafting policies and procedures, leadinginterdisciplinary meetings and conferences,providing in-service teaching sessions;

(Outcome)

IV.A.5.f).(7).(b).(iii) discussions/proposals for hospital andcommunity resources including clinical,laboratory and research space, equipmentand technology necessary for the programto provide state-of-the-art care whileadvancing knowledge in the field; (Outcome)

IV.A.5.f).(7).(b).(iv) business planning and practicemanagement that includes billing andcoding, personnel management policies and

professional liability;(Outcome)

IV.A.5.f).(7).(b).(v) division or program development,organization, and maintenance; and, (Outcome)

IV.A.5.f).(7).(b).(vi) necessary collaborations within (e.g.,pathology, radiology, surgery) and beyondthe institution (e.g., participation in nationalspecialty societies, cooperative care groups,multi-center research collaboratives) asappropriate to their specialty. (Outcome)

IV.A.6. Curriculum Organization and Fellow Experiences

IV.A.6.a) Fellows must have a formally-structured educational program inthe clinical and basic sciences related to the subspecialty. (Core)

IV.A.6.a).(1) The program must utilize lectures, seminars, and practicalexperience. (Detail)

IV.A.6.a).(2) Subspecialty conferences must be regularly scheduled,




and should involve active participation by the fellows in theplanning and implementation of these meetings. (Detail)

IV.A.6.a).(3) Fellows should have an education in basic andfundamental disciplines related to each subspecialty, asappropriate, such as anatomy, physiology, biochemistry,

embryology, pathology, microbiology, pharmacology,immunology, genetics, and nutrition/metabolism. (Core)

IV.A.6.a).(4) Fellows should have instruction that includespathophysiology of disease, reviews of recent advances inclinical medicine and biomedical research, conferencesdealing with complications and death, and instruction in thescientific, ethical, and legal implications of confidentialityand of informed consent. (Core)

IV.A.6.a).(5) Bioethics must be addressed in the formal curriculum. (Core)

IV.A.6.a).(5).(a) This must include attention to physician-patient,physician-family, physician-physician/allied healthprofessional, and physician-society relationships.

(Detail)

IV.A.6.a).(6) Fellows should have instruction in such topics as theeconomics of health care and current health caremanagement issues, such as cost-effective patient care,practice management, preventive care, qualityimprovement, resource allocation, and clinical outcomes.(Detail)

IV.B. Fellows’ Scholarly Activities

IV.B.1. The curriculum must advance fellows’ knowledge of the basicprinciples of research, including how research is conducted,evaluated, explained to patients, and applied to patient care. (Core)

IV.B.2. Fellows should participate in scholarly activity. (Core)

IV.B.2.a) Each fellow must design and conduct a scholarly project in his or her subspecialty area with the guidance of the fellowship director and a designated mentor. (Core)

IV.B.2.b) The program must provide a scholarship oversight committee for each fellow to evaluate the fellow’s progress as related toscholarly activity. (Core)

IV.B.2.c) The scholarly experience must begin in the first year and continuefor the entire period of training. (Detail)

IV.B.2.c).(1) Time must be adequate to allow for the development of requisite skills, project completion, and presentation of




results to a local scholarship oversight committeeestablished for this review. (Detail)

IV.B.2.c).(1).(a) Where applicable, the process of establishingfellow scholarship oversight committees should bea collaborative effort involving other pediatric

subspecialty programs in the institution. (Detail)

IV.B.3. The sponsoring institution and program should allocate adequateeducational resources to facilitate fellow involvement in scholarlyactivities. (Detail)

V. Evaluation

V.A. Fellow Evaluation

V.A.1. Formative Evaluation

V.A.1.a) The faculty must evaluate fellow performance in a timelymanner during each rotation or similar educationalassignment, and document this evaluation at completion of the assignment. (Core)

V.A.1.b) The program must:

V.A.1.b).(1) provide objective assessments of competence inpatient care and procedural skills, medical knowledge,practice-based learning and improvement,interpersonal and communication skills,professionalism, and systems-based practice based

on the specialty-specific Milestones;(Core)

V.A.1.b).(2) use multiple evaluators (e.g., faculty, peers, patients,self, and other professional staff); (Detail)

V.A.1.b).(3) document progressive fellow performanceimprovement appropriate to educational level; and,(Core)

V.A.1.b).(4) provide each fellow with documented semiannualevaluation of performance with feedback. (Core)

V.A.1.c) The evaluations of fellow performance must be accessible for review by the fellow, in accordance with institutional policy.(Detail)

V.A.2. Summative Evaluation

V.A.2.a) The specialty-specific Milestones must be used as one of thetools to ensure fellows are able to practice core professionalactivities without supervision upon completion of the




program. (Core)

V.A.2.b) The program director must provide a summative evaluationfor each fellow upon completion of the program. (Core)

This evaluation must:

V.A.2.b).(1) become part of the fellow’s permanent recordmaintained by the institution, and must be accessiblefor review by the fellow in accordance withinstitutional policy; (Detail)

V.A.2.b).(2) document the fellow’s performance during the finalperiod of education; and, (Detail)

V.A.2.b).(3) verify that the fellow has demonstrated sufficientcompetence to enter practice without directsupervision. (Detail)

V.B. Faculty Evaluation

V.B.1. At least annually, the program must evaluate faculty performance asit relates to the educational program. (Core)

V.B.2. These evaluations should include a review of the faculty’s clinicalteaching abilities, commitment to the educational program, clinicalknowledge, professionalism, and scholarly activities. (Detail)

V.B.3. This evaluation must include at least annual written confidentialevaluations by the fellows. (Detail)

V.B.3.a) In order to maintain the confidentiality of responses from fellows insmall programs, evaluations of faculty may be consolidated withthe core faculty evaluations. (Detail)

V.B.4. Faculty should receive formal feedback from these evaluations. (Core)

V.C. Program Evaluation and Improvement

V.C.1. The program must document formal, systematic evaluation of thecurriculum at least annually. (Core)

The program must monitor and track each of the following areas:

V.C.1.a) fellow performance; (Core)

V.C.1.b) faculty development; (Core)

V.C.1.c) graduate performance, including performance of programgraduates on the certification examination; and, (Core)




V.C.1.d) program quality. (Core)

V.C.1.d).(1) Fellows and faculty must have the opportunity toevaluate the program confidentially and in writing atleast annually, and (Detail)

V.C.1.d).(2) The program must use the results of fellows’assessments of the program together with other program evaluation results to improve the program.(Detail)

V.C.2. If deficiencies are found, the program should prepare a written planof action to document initiatives to improve performance in theareas listed in section V.C.1. (Core)

V.C.2.a) The action plan should be reviewed and approved by theteaching faculty and documented in meeting minutes. (Detail)

V.C.3. A program will be judged deficient if, over a six year period, fewer than75% of fellows eligible for the certifying examination take it and of thosewho take it, fewer than 75% pass it on the first attempt. The ReviewCommittee will take into consideration noticeable improvements or declines during this same period. (Outcome)

V.C.3.a) An exception may be made for programs with small numbers of fellows. A subspecialty program director will be expected toprovide the requested information at the time of each review. (Detail)

V.C.4. The same evaluation mechanisms used in the related pediatricsresidency program must be adapted for and implemented in all of the

pediatric subspecialty programs that function with it.(Detail)

VI. Fellow Duty Hours in the Learning and Working Environment

VI.A. Professionalism, Personal Responsibility, and Patient Safety

VI.A.1. Programs and sponsoring institutions must educate fellows andfaculty members concerning the professional responsibilities of physicians to appear for duty appropriately rested and fit to providethe services required by their patients. (Core)

VI.A.2. The program must be committed to and responsible for promoting

patient safety and fellow well-being in a supportive educationalenvironment. (Core)

VI.A.3. The program director must ensure that fellows are integrated andactively participate in interdisciplinary clinical quality improvementand patient safety programs. (Core)

VI.A.4. The learning objectives of the program must:




VI.A.4.a) be accomplished through an appropriate blend of supervisedpatient care responsibilities, clinical teaching, and didacticeducational events; and, (Core)

VI.A.4.b) not be compromised by excessive reliance on fellows to fulfillnon-physician service obligations. (Core)

VI.A.5. The program director and institution must ensure a culture of professionalism that supports patient safety and personalresponsibility. (Core)

VI.A.6. Fellows and faculty members must demonstrate an understandingand acceptance of their personal role in the following:

VI.A.6.a) assurance of the safety and welfare of patients entrusted totheir care; (Outcome)

VI.A.6.b) provision of patient- and family-centered care; (Outcome)

VI.A.6.c) assurance of their fitness for duty; (Outcome)

VI.A.6.d) management of their time before, during, and after clinicalassignments; (Outcome)

VI.A.6.e) recognition of impairment, including illness and fatigue, inthemselves and in their peers; (Outcome)

VI.A.6.f) attention to lifelong learning; (Outcome)

VI.A.6.g) the monitoring of their patient care performance improvement

indicators; and,(Outcome)

VI.A.6.h) honest and accurate reporting of duty hours, patientoutcomes, and clinical experience data. (Outcome)

VI.A.7. All fellows and faculty members must demonstrate responsivenessto patient needs that supersedes self-interest. They must recognizethat under certain circumstances, the best interests of the patientmay be served by transitioning that patient’s care to another qualified and rested provider. (Outcome)

VI.B. Transitions of Care

VI.B.1. Programs must design clinical assignments to minimize the number of transitions in patient care. (Core)

VI.B.2. Sponsoring institutions and programs must ensure and monitor effective, structured hand-over processes to facilitate bothcontinuity of care and patient safety. (Core)

VI.B.3. Programs must ensure that fellows are competent in communicating




with team members in the hand-over process. (Outcome)

VI.B.4. The sponsoring institution must ensure the availability of schedulesthat inform all members of the health care team of attendingphysicians and fellows currently responsible for each patient’s care. (Detail)

VI.C. Alertness Management/Fatigue Mitigation

VI.C.1. The program must:

VI.C.1.a) educate all faculty members and fellows to recognize thesigns of fatigue and sleep deprivation; (Core)

VI.C.1.b) educate all faculty members and fellows in alertnessmanagement and fatigue mitigation processes; and, (Core)

VI.C.1.c) adopt fatigue mitigation processes to manage the potential

negative effects of fatigue on patient care and learning, suchas naps or back-up call schedules. (Detail)

VI.C.2. Each program must have a process to ensure continuity of patientcare in the event that a fellow may be unable to perform his/her patient care duties. (Core)

VI.C.3. The sponsoring institution must provide adequate sleep facilitiesand/or safe transportation options for fellows who may be toofatigued to safely return home. (Core)

VI.D. Supervision of Fellows

VI.D.1. In the clinical learning environment, each patient must have anidentifiable, appropriately-credentialed and privileged attendingphysician (or licensed independent practitioner as approved by eachReview Committee) who is ultimately responsible for that patient’scare. (Core)

VI.D.1.a) This information should be available to fellows, facultymembers, and patients. (Detail)

VI.D.1.b) Fellows and faculty members should inform patients of their respective roles in each patient’s care. (Detail)

VI.D.2. The program must demonstrate that the appropriate level of supervision is in place for all fellows who care for patients. (Core)

Supervision may be exercised through a variety of methods. Someactivities require the physical presence of the supervising facultymember. For many aspects of patient care, the supervisingphysician may be a more advanced resident or fellow. Other portions of care provided by the fellow can be adequately




supervised by the immediate availability of the supervising facultymember or fellow physician, either in the institution, or by means of telephonic and/or electronic modalities. In some circumstances,supervision may include post-hoc review of fellow-delivered carewith feedback as to the appropriateness of that care. (Detail)

VI.D.3. Levels of Supervision

To ensure oversight of fellow supervision and graded authority andresponsibility, the program must use the following classification of supervision: (Core)

VI.D.3.a) Direct Supervision – the supervising physician is physicallypresent with the fellow and patient. (Core)

VI.D.3.b) Indirect Supervision:

VI.D.3.b).(1) with direct supervision immediately available – the

supervising physician is physically within the hospitalor other site of patient care, and is immediatelyavailable to provide Direct Supervision. (Core)

VI.D.3.b).(2) with direct supervision available – the supervisingphysician is not physically present within the hospitalor other site of patient care, but is immediatelyavailable by means of telephonic and/or electronicmodalities, and is available to provide DirectSupervision. (Core)

VI.D.3.c) Oversight – the supervising physician is available to provide

review of procedures/encounters with feedback providedafter care is delivered. (Core)

VI.D.4. The privilege of progressive authority and responsibility, conditionalindependence, and a supervisory role in patient care delegated toeach fellow must be assigned by the program director and facultymembers. (Core)

VI.D.4.a) The program director must evaluate each fellow’s abilitiesbased on specific criteria. When available, evaluation shouldbe guided by specific national standards-based criteria. (Core)

VI.D.4.b) Faculty members functioning as supervising physiciansshould delegate portions of care to fellows, based on theneeds of the patient and the skills of the fellows. (Detail)

VI.D.4.c) Senior residents or fellows should serve in a supervisory roleof junior residents in recognition of their progress towardindependence, based on the needs of each patient and theskills of the individual resident or fellow. (Detail)




VI.D.5. Programs must set guidelines for circumstances and events inwhich fellows must communicate with appropriate supervisingfaculty members, such as the transfer of a patient to an intensivecare unit, or end-of-life decisions. (Core)

VI.D.5.a) Each fellow must know the limits of his/her scope of

authority, and the circumstances under which he/she ispermitted to act with conditional independence. (Outcome)

VI.D.5.a).(1) In particular, PGY-1 residents should be supervisedeither directly or indirectly with direct supervisionimmediately available. (Core)

VI.D.6. Faculty supervision assignments should be of sufficient duration toassess the knowledge and skills of each fellow and delegate tohim/her the appropriate level of patient care authority andresponsibility. (Detail)

VI.E. Clinical Responsibilities

The clinical responsibilities for each fellow must be based on PGY-level,patient safety, fellow education, severity and complexity of patientillness/condition and available support services. (Core)

VI.E.1. The program director must have the authority and responsibility to setappropriate clinical responsibilities (i.e., patient caps) for each fellowbased on the PGY-level, patient safety, fellow education, severity andcomplexity of patient illness/condition and available support services. (Core)

VI.E.2. Fellows must be responsible for maintaining an appropriate patient load.

Insufficient patient experiences do not meet educational needs; anexcessive patient load suggests an inappropriate reliance on fellows for service obligations, which may jeopardize their educational experience.

(Core)

VI.F. Teamwork

Fellows must care for patients in an environment that maximizes effectivecommunication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of carein the specialty. (Core)

VI.F.1. Interprofessional team members should participate in the education of fellows. (Detail)

VI.G. Fellow Duty Hours

VI.G.1. Maximum Hours of Work per Week

Duty hours must be limited to 80 hours per week, averaged over afour-week period, inclusive of all in-house call activities and all




moonlighting. (Core)

VI.G.1.a) Duty Hour Exceptions

A Review Committee may grant exceptions for up to 10% or amaximum of 88 hours to individual programs based on a

sound educational rationale. (Detail)

The Review Committee for Pediatrics will not consider requestsfor exceptions to the 80-hour limit to the fellows’ work week.

VI.G.1.a).(1) In preparing a request for an exception the programdirector must follow the duty hour exception policyfrom the ACGME Manual on Policies and Procedures.(Detail)

VI.G.1.a).(2) Prior to submitting the request to the ReviewCommittee, the program director must obtain approval

of the institution’s GMEC and DIO. (Detail)

VI.G.2. Moonlighting

VI.G.2.a) Moonlighting must not interfere with the ability of the fellowto achieve the goals and objectives of the educationalprogram. (Core)

VI.G.2.b) Time spent by fellows in Internal and External Moonlighting(as defined in the ACGME Glossary of Terms) must becounted towards the 80-hour Maximum Weekly Hour Limit.(Core)

VI.G.2.c) PGY-1 residents are not permitted to moonlight. (Core)

VI.G.3. Mandatory Time Free of Duty

Fellows must be scheduled for a minimum of one day free of dutyevery week (when averaged over four weeks). At-home call cannotbe assigned on these free days. (Core)

VI.G.4. Maximum Duty Period Length

VI.G.4.a) Duty periods of PGY-1 residents must not exceed 16 hours in

duration.(Core)

VI.G.4.b) Duty periods of PGY-2 residents and above may bescheduled to a maximum of 24 hours of continuous duty inthe hospital. (Core)

VI.G.4.b).(1) Programs must encourage fellows to use alertnessmanagement strategies in the context of patient careresponsibilities. Strategic napping, especially after 16




hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested. (Detail)

VI.G.4.b).(2) It is essential for patient safety and fellow educationthat effective transitions in care occur. Fellows may beallowed to remain on-site in order to accomplish these

tasks; however, this period of time must be no longer than an additional four hours. (Core)

VI.G.4.b).(3) Fellows must not be assigned additional clinicalresponsibilities after 24 hours of continuous in-houseduty. (Core)

VI.G.4.b).(4) In unusual circumstances, fellows, on their owninitiative, may remain beyond their scheduled periodof duty to continue to provide care to a single patient.Justifications for such extensions of duty are limitedto reasons of required continuity for a severely ill or

unstable patient, academic importance of the eventstranspiring, or humanistic attention to the needs of apatient or family. (Detail)

VI.G.4.b).(4).(a) Under those circumstances, the fellow must:

VI.G.4.b).(4).(a).(i) appropriately hand over the care of allother patients to the team responsiblefor their continuing care; and, (Detail)

VI.G.4.b).(4).(a).(ii) document the reasons for remaining tocare for the patient in question and

submit that documentation in everycircumstance to the program director.(Detail)

VI.G.4.b).(4).(b) The program director must review eachsubmission of additional service, and trackboth individual fellow and program-wideepisodes of additional duty. (Detail)

VI.G.5. Minimum Time Off between Scheduled Duty Periods

VI.G.5.a) PGY-1 residents should have 10 hours, and must have eight

hours, free of duty between scheduled duty periods.(Core)

VI.G.5.b) Intermediate-level residents should have 10 hours free of duty, and must have eight hours between scheduled dutyperiods. They must have at least 14 hours free of duty after 24hours of in-house duty. (Core)

VI.G.5.c) Residents in the final years of education must be prepared toenter the unsupervised practice of medicine and care for




patients over irregular or extended periods. (Outcome)

Pediatric subspecialty fellows in the PGY-4 level and beyond areconsidered to be in the final years of education.

VI.G.5.c).(1) This preparation must occur within the context of the

80-hour, maximum duty period length, and one-day-off-in-seven standards. While it is desirable thatresidents in their final years of education have eighthours free of duty between scheduled duty periods,there may be circumstances when these fellows muststay on duty to care for their patients or return to thehospital with fewer than eight hours free of duty. (Detail)

VI.G.5.c).(1).(a) Circumstances of return-to-hospital activitieswith fewer than eight hours away from thehospital by residents in their final years of education must be monitored by the program

director. (Detail)

VI.G.5.c).(1).(b) The Review Committee defines suchcircumstances as: required continuity of care for aseverely ill or unstable patient, or a complex patientwith whom the fellow has been involved; events of exceptional educational value; or, humanisticattention to the needs of a patient or family.

VI.G.6. Maximum Frequency of In-House Night Float

Fellows must not be scheduled for more than six consecutive nights

of night float.(Core)

VI.G.6.a) Fellows should not have more than one consecutive week of nightfloat, and not more than four total weeks of night float per year.

(Detail)

VI.G.7. Maximum In-House On-Call Frequency

PGY-2 residents and above must be scheduled for in-house call nomore frequently than every-third-night (when averaged over a four-week period). (Core)

VI.G.8. At-Home Call

VI.G.8.a) Time spent in the hospital by fellows on at-home call mustcount towards the 80-hour maximum weekly hour limit. Thefrequency of at-home call is not subject to the every-third-night limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks. (Core)

VI.G.8.a).(1) At-home call must not be so frequent or taxing as to




preclude rest or reasonable personal time for eachfellow. (Core)

VI.G.8.b) Fellows are permitted to return to the hospital while on at-home call to care for new or established patients. Eachepisode of this type of care, while it must be included in the

80-hour weekly maximum, will not initiate a new “off -dutyperiod”. (Detail)

***

*Core Requirements: Statements that define structure, resource, or process elements essential to everygraduate medical educational program.Detail Requirements: Statements that describe a specific structure, resource, or process for achievingcompliance with a Core Requirement. Programs in substantial compliance with the OutcomeRequirements may utilize alternative or innovative approaches to meet Core Requirements.Outcome Requirements: Statements that specify expected measurable or observable attributes(knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medicaleducation.



Pediatric Neonatal-Perinatal Medicine 1

ACGME Program Requirements for Graduate Medical Educationin Neonatal-Perinatal Medicine

Introduction

Int.A. Scope of Training

Int.A.1. Neonatal-perinatal medicine programs provide fellows with thebackground to understand the physiology and altered structure andfunction of the fetus and the neonate, and to diagnose and manageproblems of the neonate.

Int.A.2. The program must emphasize the fundamentals of clinical diagnosis andmanagement of problems seen in the continuum of development from theprenatal through the intrapartum and neonatal periods, includingassessment of outcomes. (Core)*

VII. Institutions

An accredited program in neonatal-perinatal medicine must be affiliated with a residencyprogram in obstetrics and gynecology accredited by the Accreditation Council for Graduate Medical Education (ACGME). (Core)

VII.A. The obstetrics and gynecology program must be within the same geographiclocation and have board-certified maternal-fetal medicine specialists. (Core)

VIII. Program Personnel and Resources

VIII.A. Faculty

VIII.A.1. An accredited program must have at least four full-time neonatologistsactively contributing sufficient time and effort to the educational programto fulfill the supervisory, teaching, and mentoring requirements of theprogram. (Core)

VIII.A.2. The program must include the full range of pediatric subspecialistsnecessary for teaching and consultation. (Core)

VIII.A.2.a) In addition, appropriate consultants must be available in relateddisciplines, including: a pediatric neurologist, a geneticist, aconsultant skilled in neurodevelopment, and a pediatricradiologist. (Detail)

VIII.A.3. Each program must have a full range of surgical subspecialists withexperience in pediatrics necessary for teaching and consultation. (Core)

VIII.A.3.a) This should include consultant faculty in: pediatric surgery,neurological surgery, ophthalmology, orthopaedic surgery,otolaryngology, urology, and cardiothoracic surgery. (Detail)

VIII.B. Other Program Personnel




The following professional staff, skilled in the care of critically ill and/or prematureneonates, are essential: nurses, respiratory therapists, pharmacists, nutritionistsskilled in the management of both enteral and parenteral nutrition, therapistsskilled in evaluating feeding difficulties initially or in follow up, medical socialworkers skilled in management of families in crisis and end-of-life care,

specialists in physical and occupational therapy applied in a developmentallyappropriate way, and specialists in the assessment of hearing. (Detail)

VIII.C. Resources

VIII.C.1. A specially-designated neonatal intensive care unit (NICU) must belocated in the primary teaching site. (Core)

VIII.C.1.a) Facilities and equipment in that unit must meet the generally-accepted standards of modern intensive care units, andappropriate laboratory services must be available 24 hours a day.(Core)

VIII.C.1.a).(1) The facilities and resources must include: portable x-ray,ultrasound imaging, ECG, neonatal echocardiography, andEEG services on a 24 hour a day basis with 24 hour a dayinterpretation services. (Detail)

VIII.C.2. The perinatal service must have facilities and equipment which meet thegenerally-accepted standards for high-risk newborn resuscitation. (Core)

VIII.C.3. The primary teaching site must meet the generally-accepted standards for modern laboratories and services needed for management of high-riskpregnancies and critically ill neonates. (Core)

These must include:

VIII.C.3.a) microchemistry and hematology laboratories; (Detail)

VIII.C.3.b) blood gas analysis; (Detail)

VIII.C.3.c) perinatal diagnostic laboratory; (Detail)

VIII.C.3.d) pathology services, including those for evaluation of placentalpathology; (Detail)

VIII.C.3.e) diagnostic bacteriology and virology laboratories;(Detail)

VIII.C.3.f) blood bank; and, (Detail)

VIII.C.3.g) accessible CT and MRI facilities. (Detail)

VIII.C.4. The teaching sites should also have access to the following within areasonable period of time: (Detail)




VIII.C.4.a) screening laboratory for inborn errors of metabolism; (Detail)

VIII.C.4.b) clinical toxicology laboratory; (Detail)

VIII.C.4.c) nuclear medicine facilities; (Detail)

VIII.C.4.d) cytogenetics laboratory; and, (Detail)

VIII.C.4.e) audiology services. (Detail)

VIII.C.5. The program must provide the patient care experiences necessary for thefellows to acquire skill in delivery room stabilization and resuscitation of critically ill neonates. (Core)

VIII.C.5.a) To accomplish this, there must be a sufficient number and varietyof high-risk obstetrical patients to ensure that the fellows becomeknowledgeable in identifying high-risk pregnancies and evaluatingfetal well-being and maturation. (Detail)

VIII.C.6. A sufficient number of discharged infants must be available to assureappropriate outpatient experience for each fellow. (Core)

VIII.C.6.a) This should occur in a NICU follow-up clinic (Detail)

VIII.C.6.b) The clinic must have staff with expertise in performingdevelopmental assessments, as well as skilled neonatal or pediatric faculty as teachers. (Detail)

VIII.C.6.c) These experiences should enable fellows to understand therelationship between neonatal illnesses and later health and

development, and to become aware of the socioeconomic impactand psychosocial stress that such infants may place on a family.

(Detail)

IX. Educational Program

IX.A. Patient Care

IX.A.1. Fellows must demonstrate competence and effective participation inteam-based care of critically-ill patients whose primary problem issurgical. (Outcome)

IX.A.1.a) To meet these goals, the coordination of care and collegialrelationships between pediatric surgeons, neonatologists, andcritical care intensivists concerning the management of medicalproblems in these complex critically ill patients are essential. (Detail)

IX.A.2. Fellows must be competent to manage critically-ill neonates. (Outcome)

IX.A.2.a) In addition to the general principles of critical care, this shouldinclude, but not be limited to, techniques of neonatal resuscitation,




venous and arterial access, evacuation of air leaks, endotrachealintubation, preparation for transport, ventilatory support,continuous monitoring, temperature control, and nutritionalsupport. (Outcome)

IX.A.3. Fellows must have an understanding of the psychosocial implications of

disorders of the fetus, neonate, and young infant, as well as in the familydynamics surrounding the birth and care of a sick neonate. (Outcome)

IX.A.3.a) The fellows should demonstrate competence in patientconsultation, communication with referring physicians, and inorganizing transport of neonates within the framework of anintegrated regional system with different levels of perinatal care.(Outcome)

IX.A.3.b) They should also receive instruction about and participate in theeducation of physicians and other healthcare professionalsregarding emerging issues and factors impacting regional

perinatal morbidity and mortality. (Detail)

IX.A.4. Fellows must have the skills to identify the high-risk pregnancy, and mustbecome familiar with the methods used to evaluate fetal well-being andmaturation. (Outcome)

IX.A.4.a) Fellows must be competent to recognize the factors that maycompromise the fetus during the intrapartum period, andrecognize the signs of fetal distress. (Outcome)

IX.A.4.b) In addition, fellows must participate in the follow-up of high-riskneonates. (Detail)

IX.A.5. Fellows must be effective consultants in neonatal-perinatal medicine.(Outcome)

IX.A.5.a) Fellows must be competent to conduct and interpret relevantscholarly efforts in neonatal-perinatal medicine, to teach neonatal-perinatal medicine effectively, and to be effective administratorsand leaders in the field. (Outcome)

IX.A.6. Fellows must be skilled in the diagnosis and management of critically-illneonates with diverse conditions. (Outcome)

IX.A.6.a) Fellows must be skilled in the management of neonates whorequire ventilatory assistance. (Outcome)

IX.A.6.b) In addition, fellows must acquire knowledge of, and participate in,the care of neonates requiring cardiac surgical procedures (andtheir postoperative complications). (Detail)

IX.A.7. A neonatal database of all patient admissions, diagnoses, and outcomesmust be used for fellow education. (Core)



IX.A.7.a) Fellows should demonstrate knowledge of the tabulation andevaluation of an institutional database. (Outcome)

IX.A.7.a).(1) Exposure to a regional or national fetal and neonatalmorbidity and mortality database is encouraged. (Detail)

IX.A.7.b) Fellows should be competent to apply techniques of collation andcritical interpretation of data pertaining to immediate outcome andsequelae of various diseases. (Outcome)

IX.A.7.b).(1) This experience should be closely related to theevaluations of various modalities of therapy used in thesedisorders. (Detail)

IX.B. Medical Knowledge

IX.B.1. The program must provide fellows with instruction in related basic

sciences. (Core)

IX.B.1.a) Seminars, conferences, and courses must be offered in the basicdisciplines related to pregnancy, the fetus, and the neonate. (Detail)

IX.B.1.a).(1) This should include maternal physiological, biochemical,and pharmacological influences on the fetus; fetalphysiology; fetal development; placental function (placentalcirculation, gas exchange, growth); physiological andbiochemical adaptation to birth; cellular, molecular, anddevelopmental biology and pathology relevant to diseasesof the neonate; psychology of pregnancy and maternal-

infant interaction; breast feeding and lactation; growth andnutrition; and genetics. (Detail)

IX.B.2. Fellows should also participate in regularly-scheduled multidisciplinaryconferences, such as case conferences and those that review perinatalmortality and morbidity. (Detail)

***

*Core Requirements: Statements that define structure, resource, or process elements essential to everygraduate medical educational program.Detail Requirements: Statements that describe a specific structure, resource, or process, for achievingcompliance with a Core Requirement. Programs in substantial compliance with the OutcomeRequirements may utilize alternative or innovative approaches to meet Core Requirements.Outcome Requirements: Statements that specify expected measurable or observable attributes(knowledge, abilities, skills, or attitudes) of residents or fellows at key stages of their graduate medicaleducation.

Documents

329 Neonatal Perinatal Peds 07012013